P1612: ACUTE MYELOID LEUKEMIA IN ADULT PATIENTS: FEATURES OF TREATMENT IN CONTEXT OF THE COVID-19 PANDEMIC.
Authors: T. Tolstykh, E. Baryakh, D. Ivanova, T. Chudnova, M. Misyurina, E. Medvedovskaya, M. Litvinenko, Y. Polyakov, O. Kochneva
Journal: HemaSphere (2022)

Background: Acute myeloid leukemia (AML) is a disease with a poor prognosis and a high mortality rate, while patients with acute myeloid leukemia are at increased risk of complications from COVID-19 infection. Aims: To investigate the treatment effectiveness and survival of patients with AML who had the COVID-19 diagnosis confirmed, as well as evaluating predictors of hospital mortality among this group of patients. Methods: From April 2020 to November 2021, Moscow City Clinical Hospital 52 treated 149 patients with AML who had the COVID-19 diagnosis confirmed, with a median age of 61 years (range 18-91), while 56% of patients were over 60 years old. An equal ratio of men and women was performed, 70 and 79 respectively. 13% were diagnosed with APL, while the remaining 87% had other variants of AML. At the time of hospitalization the most of the patients admitted had first- or second-degree pulmonary lesions (28 and 35%, respectively), while 31% of patients performed more severe lesions and the other 6% had no pulmonary damage detected, but they had a positive PCR. At the time of hospitalization, 10 out of 149 patients (7%) achieved complete remissions (CR) and were withdrawn from therapy; 41 patients (28%) were diagnosed with AML for the first time in our clinic; and 98 patients (65%) were already in process of AML treatment in other clinics. The effectiveness of treatment was assessed by the frequency of CR, as well as by the amount of cases of lethality and in-hospital survival rates. The analysis of treatment results was performed as at 01 November 2021. Results: 60 patients (38%) with AML (excluding APL) and confirmed COVID19 received anti-tumor treatment. Palliative care was received by 23 patients (38%), these were predominantly elderly patients with a median age of 71 years (range 45-91 years), with severe COVID-19. 19 patients (32%) with a median age of 38 years (range 21-61 years) received the 7 + 3 treatment protocol. While 18 elderly patients (30%) with a median age of 70 years (range 60-85 years) received the low intensity therapy (low doses of cytarabine, hypomethylation therapy and venetoclax containing regimens). As a result of COVID-19, 79 patients (54%) died. The main factor determining the high mortality rate in our study was the absence of AML CR. The Survival of patients in CR was 96.3±3.6%, which means almost all patients have recovered from COVID-19 and were discharged to continue their treatment in other medical institutions. For patients out of remission and primary patients with AML the survival rate was 38.0±6.5% and 33.7±8.7%, respectively. For the purposes of analyzes of predictors of survival, we divided our patients into 2 groups, due to a great variety of prognosis. Remission status essentially outweighs all other factors, including presence of significant comorbidities, AML variants, isolated cytopenias, severity of COVID-19 (CT, CRP, D-dimer, etc.), nature of AML therapy and other factors. In the group of patients out of AML remission the negative predictive value for hospital survival was shown by age over 60 years, as well as by agranulocytosis, CT 3-4, the use of GCS and transfer to the ICU. Summary/Conclusion: The diagnosis of COVID-19 in patients with AML greatly worsens their life prognosis. The leading predictor of mortality becomes the lack of remission of AML. Thus, antitumor treatment allows achieving CR, which in turn reduces the risk of developing a severe course of coronavirus infection.